April 2013 Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine

 

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Emory general surgery residency to assess innovative new training paradigm

Dr. Keith Delman (center) with residents Swetha Ramakrishna and Harrell Lightfoot.
Dr. Keith Delman (center) with residents Swetha Ramakrishna and Harrell Lightfoot.

As a member of a 10-institution consortium that includes Brigham and Women's Hospital, Cornell University, Johns Hopkins, Massachusetts General Hospital, Northwestern University, Oregon Health and Science University, University of Oklahoma, University of Southern California, and Washington University in Saint Louis, the general surgery residency program of the Emory University School of Medicine will role out a pilot program entitled Flexibility in Surgical Training (FIST) in July 2013. By reviewing and collating their collective experiences with FIST, the consortium will evaluate the impact of enacting the American Board of Surgery's 2011-approved policy that allows up to 12 months of flexible rotations in the last 36 months of general surgery training. In deviation from the focus of traditional residencies, this type of specialty training gives program directors the opportunity to tailor training to residents' future career interests.

"Up until this pilot, the early specialization training allowed by this flexibility rule only comprised vascular or cardiothoracic surgery," says Dr. Keith Delman, program director of Emory's general surgery residency. "Each of the FIST centers will offer additional early specialization experiences, such as advanced GI, acute care surgery, surgical oncology, endocrine and breast at MGH, or transplant, breast, advanced GI, hepatobiliary, CRS, surgical critical care, and pediatric surgery at Johns Hopkins. Emory will have residents pursuing flexibility training in plastics, transplant, surgical oncology, endocrine, advanced GI, comprehensive general surgery, and the early specialization versions of vascular surgery and cardiothoracic surgery."

FIST trainees will be monitored and followed from training through certification in their intended specialty. Outcomes criteria to be examined will include case numbers; formative and summative assessments from components of the particular training programs, such as operative performance rating systems; annual ABSITE results for both participants and non-participants; completion of specified core and specialty specific SCORE modules; and several other measures. The pilot is expected to last a minimum of five years. "As we collect, analyze, and report the data, we plan on sharing it with the RRC, ACGME, and ABS to help formulate best practices in applying the flexibility rule," says Dr. Delman.

One of the consortium's primary concerns is observing that the quality of non-participants' training experience is unaffected by the presence of various focused tracks. To qualify for the pilot, the host institutions had to have sufficient clinical material to support the training of both participants and non-participants, and those measures that encompass traditional general surgery residents and those in specialized tracks—such as examination of case logs—will be inspected closely to insure that nonparticipants are not adversely affected. In fact, supporters of the flexibility ruling believe that the incorporation of focused training into general surgery residencies will also benefit those pursuing general surgery, which is in fact its own specialty, and improve their overall training experience.

"We anticipate that the multi-institutional foundation of the pilot will let us document the impact and outcome of the flexibility rule faster and more fully than a single institution could," says Dr. Delman. "We also suspect that the pilot will vindicate the concept that graduates with additional clinical experience in their area of eventual practice will be more comfortable with independent practice immediately following training, and that these graduates will be better prepared to provide quality surgical care to their patients with improved outcomes."

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Dr. Grace Rozycki
Dr. Rozycki
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Dr. Anuradha Subramanian
Dr. Subramanian

Dr. Subramanian appointed new Grady SICU Medical Director as Dr. Rozycki leaves for Indiana University

Several of the Emory general surgeons that staff the trauma/surgical critical care service at Grady Memorial Hospital also did their trauma/surgical critical training at the public hospital's Level I trauma center. One of these is Dr. Anuradha Subramanian, the most recent appointee to the service, who completed her trauma/surgical critical care fellowship at Grady in 2007. She then joined the Baylor College of Medicine, served as director of medical student education, and held various leadership roles at Michael E. DeBakey VA Medical Center. When she returned to Grady in 2012 to be associate director of the Surgical Intensive Care Unit and associate program director of the Trauma/Surgical Critical Care Fellowship, she renewed her connection to the original source of her motivation to serve patients who are critically ill.

When she was a trauma/surgical critical care trainee, Dr. Subramanian's primary mentor at Grady was Dr. Grace Rozycki. Now, following Dr. Rozycki's departure from Emory after 19 years of exemplary service, Dr. Subramanian will assume Dr. Rozycki's former role as medical director of Grady's SICU. "Dr. Rozycki was not only a clinical mentor for me, but she also taught me a great deal about the administrative leadership required to run an ICU," says Dr. Subramanian.

Upon returning to Grady, Dr. Subramanian engaged in various cooperative efforts that highlighted her dedication to progressive patient care, research, and education. She collaborated with the neurosurgery critical care and ICU services on the development of a protocol for elevated intracranial pressure in traumatic brain injury, partnered with members of Grady's internal medicine and ethics services on a grant to the Emory Medical Care Foundation to study the effect of incapacitated surrogateless status on physician decision-making, and initiated a weekly lecture series for the trauma fellows. Her future plans include creating a dedicated lecture series for the general surgery, emergency medicine, and oral surgery residents and medical students that rotate in the SICU.

Dr. Rozycki's transition to executive vice chair of the Department of Surgery at Indiana University School of Medicine and director of the Indiana Injury Institute closes the chapter on her years at Emory transforming Grady's trauma, emergency general surgery, and surgical critical care services as well as the surgical critical care residency. During this time she developed surgeon-performed ultrasound to the degree that it enhanced the practice of trauma surgery on a national and international level, an achievement defined most significantly by her origination of the FAST exam (Focused Assessment for Sonography of Trauma) that uses an ultrasound transducer to detect the extent of internal injury requiring immediate surgery. Her work in this area also developed the application of ultrasound in the SICU and after trauma admission.

"It is with sincere gratitude that I thank Dr. Rozycki for her years of service to Emory and the many roles she played at Grady," says Dr. Sheryl Gabram, Emory Surgeon-in-Chief of Grady. "She will be missed. Thankfully, Dr. Subramanian is an excellent choice to sustain and augment her legacy in the Surgical Intensive Care Unit."

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Dr. Edward Lin
Dr. Lin
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Dr. Juan Sarmiento
Dr. Sarmiento
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Dr. Ankit Patel
Dr. Patel
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Dr. Rachel Owen
Dr. Owen

Emory Endosurgery Unit faculty and fellows among the forefront at SAGES annual meeting

The Emory Endosurgery Unit's commitment to advancing minimally invasive surgery through education was clearly demonstrated at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2013 Annual Meeting in Baltimore, April 17-20. Entitled "Innovating the Present for the Future," the conference highlighted technological innovations and medical breakthroughs in the fields of general, gastrointestinal, minimally invasive, and robotic surgery, and featured the latest hands-on surgical training and practice.

"I'm extremely proud of the quality of the presentations given by our faculty and fellows," says Dr. Edward Lin, associate professor of surgery of Emory University School of Medicine and director of the Endosurgery Unit. "The fact that our program was one of the first of its type in the country when it was formed in 1992 still drives us to be progressive and forward looking."

Emory faculty surgeon and innovator Dr. Juan Sarmiento and endosurgery research fellow Dr. Juan Toro screened an enthusiastically received video detailing the techniques involved with laparoscopic isolated caudate lobectomy for hemangioma, a procedure that Dr. Sarmiento has been heavily involved with refining at Emory. "Dr. Sarmiento has really lead the way in creating a reproducible and consistent way of performing minimally invasive liver surgery. If you shot a video of his procedure today and compared it with another from last year, it would look almost identical," says Dr. Lin.

Dr. Toro presented another video that described the Emory-based approach to transanal microscopic surgery for removing rectal tumors, a technique that features closure techniques developed by Dr. Lin, Dr. Virginia Shaffer, and Dr. Patrick Sullivan. "Being able to perform low rectal tumor surgery using this technique in selected patients often spares them very aggressive and debilitating surgery," Dr. Lin comments. "The better we get at closure techniques, the more we are able to do for these patients."

The unit's video presentations also included a video depicting techniques used by Emory general surgeons to perform laparoscopic gastrectomy with D2 lymphadenectomy for stomach cancer that was shown and discussed by Emory endosurgery clinical fellow Dr. Nathan Lytle.

"Can We Become Better Robot Surgeons Through Simulator Practice?" was presented by Dr. Ankit Patel, an endosurgery fellow who will be joining the faculty of the Department of Surgery this September. The paper described the basic skills required for robotic surgery that can be introduced and exercised via simulator training, and listed the skill-development benchmarks that should be achieved by new surgeons who wish to adopt robot surgery platforms. "This work was a collaborative effort with our business team and our surgeons," Dr. Lin adds.

Dr. Rachel Owen, an Emory resident on research sabbatical who is involved with a variety of quality projects, presented "Impact of Operative Duration on Postoperative Pulmonary Complications in Laparoscopic vs. Open Colectomy" during one of the conference's two plenary sessions. The paper described an Emory study that evaluated the effect of operative duration in laparoscopic colectomy (LC) and open colectomy (OC) on the development of postoperative pulmonary complications (PPC). Among other conclusions, the study found that LC was associated with significantly lower rates of PPC, even when operative time was substantially longer than OC. On a quality level, these observations could be particularly significant due to the fact that PPC is costly and increases risk of patient readmission. "This work by Dr. Owens and lead author Dr. John Sweeney was one of the top papers presented at this year's meeting," remarked Dr. Lin.

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Dr. Padala's international research garners Leducq Foundation praise

Dr. Padala
Dr. Padala

"The Career Development Award was designed with investigators like you in mind: engineers and others who could turn their expertise towards cardiovascular disease, working in a multidisciplinary fashion on some of the complex questions in the field. The foundation is impressed with what you have accomplished, and proud to be supporting your work," reads the letter of congratulations from Dr. David Tancredi, scientific director of the Leducq Foundation, to Dr. Muralidhar Padala, director of the Structural Heart Disease Research and Innovation Lab of the Emory University School of Medicine.

Located in Paris, France, the private, endowment-based Leducq Foundation is dedicated to improving human health through funding and facilitating international efforts to combat cardiovascular and neurovascular disease.

The letter follows Dr. Padala's presentation at the Leducq Foundation's annual symposium in Nice, France, where he described his recent work as one of several investigators in the international "Mitral Valve Disease: From Genetic Mechanisms to Improved Repair" network. Dr. Padala's membership in the network was initiated by his receipt of the 2010-2011 Leducq Career Development Award, a recognition that supports the development of young investigators in cardiovascular and/or neurovascular disease from Europe and the United States by allowing them to engage in international, collaborative research in one of the foundation's Transatlantic Networks of Excellence.

The international consortium of leading scientists of the mitral valve disease group are studying the mysterious underlying biology of the mitral valve in hopes of describing the factors which control its biological degeneration and to encourage new thinking in the treatment of mitral valve disease. Dr. Padala's role in the network is to investigate the connection that identified genetic mutations have to altered mechanotransduction in the valve leaflets.

During his presentation, Dr. Padala detailed the efforts he has made related to his career development award, particularly his work towards understanding the impact of mutations in the gene that codes filamin A protein and its role in helping the cells to sense mechanical forces and adapt to their surrounding hemodynamic environment.

Dr. Padala's Emory lab is an interdisciplinary environment comprised of cardiac surgeons, engineers, and molecular biologists, making it a concise, Emory-based analog for the cooperative and open-bordered philosophy that the Leducq Foundation espouses. As the lab's basic science and translational pursuits continue to break new ground, contributing to the progress of Dr. Padala's work for the Leducq mitral valve group in the process, Emory's affect on the fight against heart disease goes world wide.

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Bariatric Surgical Patient Care journal cover
The original title of the journal was Bariatric Surgical Patient Care, which Dr. Lin changed to encompass surgeons and the entire bariatric team.

FACULTY APPOINTMENTS AND AWARDS

Dr. Lin appointed Editor-In-Chief of Bariatric Surgical Practice and Patient Care

Dr. Edward Lin, surgical director of the Emory Bariatric Center among other appointments, has been appointed editor-in-chief of Bariatric Surgical Practice and Patient Care. Dr. Lin has authored numerous peer-reviewed articles and chapters on topics involving bariatric and gastrointestinal surgery, metabolism, and nutritional support, and also serves on the editorial board of Bariatric Times. "I suspect the publishers wanted 'Emory' as much as someone from Emory," says Dr. Lin. "It is a testament to the work that Emory Bariatrics has done since its inception in 1999."

Dr. Kevin McConnell
Dr. McConnell

Dr. McConnell awarded Shock Society Research Fellowship

Dr. Kevin McConnell, who is a faculty attending of both the Acute and Critical Care Surgery Service and Surgical Intensive Care Unit of Emory University Hospital, has been awarded the Shock Society Research Fellowship for Early Career Investigators. The award is given to support the career development of new investigators in the areas of trauma, shock, and sepsis, and is applied to funding a project that has intrinsic importance to the field while permitting the recipient to learn the methodology, theory, and conceptualizations necessary for developing into an outstanding independent researcher.

Dr. McConnell arrived at Emory University School of Medicine in 2011 after completing his surgical critical care fellowship at Barnes-Jewish Hospital, Washington University Medical Center. His basic science and translational research focuses on the trafficking of immune cells and the use of immune modulating agents in trauma and critical illness.

Dr. Vinod Thourani
Dr. Thourani

Dr. Thourani receives prestigious McGoon Award

Dr. Vinod Thourani has been honored with the 2013 Dr. Dwight C. McGoon Award of the Thoracic Surgery Residents Association (TSRA). The McGoon Award is based on nominations from cardiothoracic surgery residents all over the country, and recognizes an outstanding young faculty member in cardiothoracic surgery and his or her commitment to resident education and mentorship. The nominees must be within the first ten years of their professional career and have demonstrated remarkable interest and ability in resident training.

In the announcement congratulating Dr. Thourani, Drs. Tom Nguyen and Samuel Youssef of the TSRA wrote: “The letters we received from your residents reflect upon your dedicated, tireless, and selfless commitment to resident education. Recognizing you and the efforts you have put forth on behalf of your trainees is one of the greatest privileges we as the TSRA can have in celebrating the most sacred tradition of surgical education.”

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Dr. Bahaaldin Alsoufi
Dr. Alsoufi

New arrival: Bahaaldin Alsoufi, MD

Assistant Professor of Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine

Dr. Alsoufi completed his general surgery residency at the University of Massachusetts, his cardiothoracic surgery residency at Oregon Health Science University, his fellowship in adult cardiac surgery at Toronto General Hospital, and his fellowship in congenital cardiac surgery at the Hospital for Sick Children in Toronto. In 2006, he joined King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, as a consultant in pediatric cardiac surgery. He also served as the chairman of mortality and morbidity and quality director. Dr. Alsoufi is a well-published author and serves on the editorial boards of BioMed Central Surgery and Journal of the Saudi Heart Association. His clinical specialties are cardiac surgery in neonates and children and congenital cardiac surgery in adults, while his research interests include clinical outcomes research, valvular heart disease, and ECMO.

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Save the Date: Emory Surgery Faculty Development Seminar

May 11, 2013, 8:00 a.m. – 12:00 p.m., WHSCAB Auditorium

While all faculty are welcome, faculty who joined the Department of Surgery after 2010 are strongly encouraged to attend this overview event for a series of seminars dedicated to equipping faculty early in their careers with the tools to be successful. Agenda items will include promotions, education, research, clinic operations, quality, and communications resources. Single-topic seminars covering most of these areas will be scheduled throughout the weeks to follow. Please contact surgery.facultydevelopment@emory.edu with any questions or concerns.

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Upcoming events

EVENT DATE/TIME LOCATION
SURGICAL GRAND ROUNDS
Decision-Making by Patients and Clinicians
Presented by Theresa W. Gillespie, PhD
– (Primary Appointment) Associate Professor, Department of Surgery, Emory University School of Medicine
– (Joint Appointment) Associate Professor, Department of Hematology and Medical Oncology, Emory University School of Medicine
– (Secondary Appointment) Clinical Associate, Nell Hodgson Woodruff School of Nursing, Emory University
– Co-Director, Health Disparities Initiative, Winship Cancer Institute
7:00 - 8:00 a.m., May 2, 2013 EUH auditorium
SURGICAL GRAND ROUNDS
GI Mucosal Imaging and Mucosal Resection: New Frontiers in GI Cancer Management
Presented by Kevin Woods, MD
– Assistant Professor of Medicine, Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine
7:00 - 8:00 a.m., May 9, 2013 EUH auditorium
Vascular Quality Initiative Regional Meeting
Sponsored by the Florida–Georgia Vascular Study Group and hosted by Dr. Yazan Duwayri and Emory University Hospital.
10:00 a.m. - 4:00 p.m., May 9, 2013 EUH

download meeting flier and agenda for more details

SURGICAL GRAND ROUNDS
13th Annual Gerald Zwiren Lecture in Pediatric Surgery
Surviving Childhood Cancer... The Rest of The Story

Presented by Richard R. Ricketts, MD
– Professor of Surgery, Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Emory-Children's Center
7:00 - 8:00 a.m., May 16, 2013 EUH auditorium
EUH Surgical Services Performance Day
A quarterly review and analysis of surgical services performance among anesthesia, surgery, and OR staff of Emory University Hospital.
7:00 - 8:00 a.m., May 23, 2013 EUH auditorium
Surgery Division Chiefs Meeting 5:30 - 7:00 p.m., May 28, 2013 EUH Whitehead Room
SURGICAL GRAND ROUNDS
8th Annual H. Harlan Stone, MD, Lecture in Trauma
Damage Control: Revolution, Rejuvenation and Recapitulation
Presented by Michael F. Rotondo, MD
– Professor and Chairman, Department of Surgery, Brody School of Medicine, East Carolina University
– Director, Center of Excellence for Trauma and Surgical Critical Care, Brody School of Medicine
– Chief of Surgery, Pitt County Memorial Hospital, University Health Systems of East Carolina
7:00 - 8:00 a.m., May 30, 2013 EUH auditorium
     
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